Turkey: The Path to Healthy Governance

In times of crisis and catastrophe, civilians are accustomed to heeding the advice of the medical community, often on matters extending beyond health. An aura of intellectual honesty and altruism seems to divorce the medical community from political bias and self-interest. However, the conduct of the Turkish medical community during last summer’s Gezi Park protests demonstrates that we must scrutinize the statements of even our most trusted professional order.

On Monday, May 27, 2013, a small group of environmentalists began a sit-in at Gezi Park, a patch of green adjacent to one of Istanbul’s main tourist attractions and monuments, Taksim Square.[1] After a few days of demonstrations, Turkish police, acting on orders from the top levels of government, donned gas masks and riot shields and evicted the protestors with tear gas and water hoses. However, this small environmental demonstration quickly escalated, growing into the largest protest movement Turkey has seen in 30 years, focused against the ruling Justice and Development Party (AKP). Over the next several weeks, Turkish riot police fired over 130,000 gas canisters at the protestors, the country’s entire yearly supply.[2] The young, poorly trained police force consistently used the gas incorrectly, firing canisters directly at protestors, into closed spaces, and at close range.[3] According to the Turkish Medical Association (TMA), eight thousand had been injured and five killed in thirteen cities by mid-July.

The Turkish medical community, led by the TMA, strongly condemned the crackdown. [4] TMA called for an end to the violence, criticized the Ministry of Health’s legal attempts to keep doctors from caring for injured protestors, and called the use of gas “savage.”[5] Such criticisms are routine in any incident of government suppression, but the statement hinted at a broader political conflict between Turkish doctors and the government:

“[The] Turkish Medical Association calls [on] the government to act responsibly and stop the barbaric violence immediately. [. . .] We urgently call the international community to act against brutal suppression of democratic demands.”[6]

The TMA did not stop at criticizing the government’s overreaction to the protests, but rather went so far as to imply that the AKP acted undemocratically and should yield to the protestors’ demands. The Turkish medical community’s reaction to the protests was not just about safeguarding civilians. Rather, Turkish doctors took advantage of the protests to inflict political damage on the AKP, with whom they were engaged in a preexisting partisan feud.

Protestors in front of the Republic Monument, which depicts Atatürk’s founding of the Turkish Republic, in Istanbul’s Taksim Square, adjacent to Gezi Park.

Not only are Turkish doctors part of the young, liberal, professional class that opposes the center-right, subtly Islamist politics of the AKP, they also share in a long tradition of zealous secularism present in Turkey since the 1920s. While most histories focus on the military’s role in Turkey’s founding, many of the Young Turks who promoted hardcore secularism during that period were originally members of the medical community. This “militant secularism” persists today. Shuaib Raza, Yale College ’14, spent the summer conducting cancer research in hospitals around Istanbul and saw the consequences firsthand. Raza explains: “People of faith are still restricted in whom they could shadow as medical residents, and it is still really difficult to find a place to pray at or around medical campuses.” It remains taboo if not explicitly prohibited to wear a veil in hospitals, medical schools, and other health areas.

Other statements by the TMA demonstrate how deep this anti-AKP bias runs. In a June 29th press release, the TMA denounced Prime Minister Erdoğan’s “projects to create ‘religiously devout generations’ fit to his thinking, his ‘ideas’ that intervene in women’s private life from abortion to fertility, his authoritarian style of governing and plans for dictatorship.”[7] Far from an objective discussion of legitimate health violations, the document is a polemic against the AKP’s political and social ideology. And their claims are sometimes less than strictly factual. In a video featured prominently on the home page of the TMA’s web site, Caghan Kizil, Ph.D., at the “Science for Gezi Conference” in New York, argued that “one can see that the lives of the people in Turkey are being treated with a mystic, agnostic, and fatalistic future. One can see that the science academies in Turkey are in crisis due to [the AKP’s] partisan approaches.”[8] Another panelist in the video presented as undisputed fact what was an unsubstantiated, perhaps totally unfounded, rumor, that Turkish police had spiked water canons with chemical agents to inflict further injury on protestors.[9] With these statements, medical advocates played into the uncertainty and hysteria surrounding the protests to take political shots at the AKP rather than sifting through fact and fiction on the ground.

Turkish doctors oppose healthcare reform undertaken by AKP. Since 2003, the AKP has revamped the Turkish healthcare system, “increasing the ratio of private to state health provision and making health care available to a larger share of the population.”[10] In just 7 years, overall satisfaction with health care services around Turkey among the public jumped from 39.5% to 73.04%.[11] The reforms improved insurance coverage, promoted competition between private and public hospitals, reduced the burden of disease, improved service, reduced private and public healthcare costs, and provided patients with new rights.[12]

However beneficial these actions were to Turkish citizens, the medical community strongly opposed them. Etem Erol, Turkish Professor at Yale, explains that the reforms stopped abusive double-billing policies, by which state doctors also sent patients to their own private practices and made sure that state doctors on the public payroll actually came to their public hospitals. Raza, along with international experts, concludes that the reforms “were both necessary and good for the consumer.”[13] Yet, as both Erol and Raza describe, doctors have taken a firm stand against the reforms and against the AKP partially because they curbed abuses and reduced the medical community’s autonomy, placing healthcare professionals under the guidance of the Ministry of Health.[14] This historically strong bias against the AKP places the TMA’s criticisms of the government crackdown in a self-interested light. The irony is that, due to the AKP healthcare reforms, the medical establishment was actually prepared to react better to injuries sustained during the anti-AKP protests than it would have been ten years ago.

Of course, this does not excuse the government’s excessive and poorly executed crackdown. Nonetheless, the response of the Turkish medical community demonstrates that observers, not only in Turkey but worldwide, must consider the political motivations behind the statements and advocacy of professional groups. Even medical organizations are not outside politics, and even their actions can serve their own financial and social interests. In many ways, the TMA’s reaction during the demonstrations was as much for political purpose as for public health. This episode demonstrates that people must remember to take the word of even trusted, purportedly unbiased medical groups with a grain of salt. Politics touches everything.